The doctor of the refugees in Romania: Nobody does a medical screening of these people

Camelia Doru

She experienced the first hours of freedom in University Square, helping the wounded on Bucharest’s streets. Starting with December 1989, Dr Camelia Doru has dedicated her life to providing healthcare services to the victims of torture of the Communist regime. In 2002, ICAR Foundation, set up by Camelia Doru, took a step further and started to focus on foreign citizens fleeing their countries of origin because of political repression or war.

With 13 years of experience in assisting refugees in Romania, Dr Camelia Doru speaks about her work and expertise, about the conditions in refugee centres and the healthcare services the state should provide to the foreign citizens arriving in our country in search of shelter.

An interview by Mihai Ivascu,

The “Refugees’ Doctor” says that the state has delegated the responsibility for the healthcare provided to refugees to non-governmental organisations and warns of a situation that could cause medical issues upon the applicants’ reception and inclusion in centres. The physician says that nobody does a medical screening of foreign citizens upon their reception. Medical screening consists of an initial examination and identification of possible diseases, anomalies or risk factors, such as TB, Hepatitis B, HIV or AIDS, in order to prevent the spreading of these diseases.

Reporter: Practically, what is it that you do to help these people? Beyond the healthcare services you offer.
Camelia Doru: Very practically, I would say that is essential. There are people who are tired, exhausted when they arrive. First of all, they are on the run, chased away. You can see very well what is happening everywhere. It is a trend originating rather from the civil society, which is starting to coagulate in a surprising manner, given the rather right-wing political orientation in Europe, and which tries to receive them as they ought to be welcome because they are people in need. They are trying to welcome them with a bottle of water, with biscuits…

Rep.: One part of Europe, that is, while the other part rejects them.
C.D: From my point of view, things are clear, you cannot not stick together with people in need, irrespective of where and when. (…) Lots of frustrations are surfacing now and are being expressed in this context. There are splendid populist attitudes that resonate extremely well with an uneducated population. People in Romania know little about these people, they were few. They were probably more before 1989, when they came to study in Romania. (…) Things are a bit different now and this discussion involves the entire society, which is not a bad thing. But the fact that the basic information is missing bothers me. Because, if on TV, we see who we see, some people who keep saying, on various channels, that “these people will come and conquer us, convert us to Islam, cut our throats, take our jobs, women and children and who knows what else”, obviously, this will result in an unfavourable trend of opinion. And this is where I expect that at least part of the media should try and speak not only with politicians, who have their own agenda, but also to the people directly involved. Let me tell one thing: most of my fellow doctors, whom I have asked to help me offer services to this group of people, turned me down.

Rep: Why is that?
C.D: Because they haven’t worked with this group and said exactly what the media is saying “Well, they bring tropical diseases, exotic diseases, we won’t spot them, I won’t take such responsibility; two, they don’t speak the language, you need an interpreter, so we’re not dealing with the typical medical relationship between two persons since there is a third one involved, and, in addition, translating means more time. All sorts of excuses which come from not knowing the group. In the end, you can work with these people using interpreters, you read a little since, essentially, the medical profession requires it from start to finish.

Rep.: Did you offer remuneration to your colleagues or were they supposed to work on a voluntary basis?
C.D: You can’t imagine that, in order to do a proper and systematic job, for 20 years, the medical profession can be sustained by volunteers, who are here today, but not tomorrow. Patients come to you according to your working hours, every day. If you’re not there, then you go home and do other things, do your job in the hospital and so no. So no, this is not possible. What is remarkable for our organisation is that, for all these 22 years, we’ve had projects all the time and paid whatever we could, not a lot, but we paid people to provide services, to be motivated to work with this group, to know them gradually and to have a normal attitude. (…)

Rep.: You mentioned earlier that there are basic things that are not being told. What are they? Could you give me an example of something which maybe you’ve come across in your field work and the media is not telling us?
C.D: I can rather say what the media is saying and should not be saying. What is the media not saying? That you won’t find among these people a crime rate that you can find among the Romanian population. Have you heard of migrants breaking and entering houses, of migrants stealing? Despite the fact that you know how much money they get per day as financial assistance: 3 Lei and..

Rep.: 3 Lei and 60 bani.
C.D: Despite this amount, which offers them a very modest lifestyle, I don’t suppose you’ve heard of such cases. This would have been just what the authorities would have wanted, to have such cases, to expose them widely in the media. There weren’t any, you haven’t heard of such cases. These people really come in search of safety and shelter. Of course that if I had to choose between Romania and Germany, if I had to leave and could get information about which one is better, I’d choose Germany. But if I couldn’t go to Germany, I’d stay in Romania because it is safe, rather than go back and have a bomb fall on my head. Slowly Romania is offering conditions for reception and for these people to continue their lives. Nobody says that these people are not socially assisted in their countries. These people have families, homes, work for a living. There is this cynical attitude of superiority in Europeans – “we are above, they are second-rank citizens”. It is absolutely false! It is only when you try to know them, talk to them that you realise how false it is. Take Iraq, for example, when many refugees came during the conflict. Iraq had a highly educated population, they were very educated and still regarded as people coming to beg. They’re not coming to beg. When they come from conflict areas, from war areas, they have international legal protection, have rights in our laws that we, out of human goodness, have promoted and we are now the first that would like to not comply with anymore. It’s all about our values. Not leave our neighbour suffer without helping. Essentially, it is what the healthcare system is doing. We contribute with a percentage from our income to these health insurances because we might need healthcare at some point, but we might also not need it …and yet we contribute. Why? Out of solidarity for those who need healthcare now.

Rep.: Are you preparing in any way for receiving the new wave of refugees?
C.D: We can prepare at individual level. As an organisation, what we could do, more than, if necessary, employ more staff, would be to recruit volunteers and train them. Working with these people – who come from another area, different cultures, other traditions – certainly implies a certain degree of training.

Rep.: Do you deal exclusively with the foreign citizens accommodated in the refugee centres or does your work also include those that have a home, but are having difficulties?
C.D: We’ve had different projects. We’ve assisted all categories of migrants, focusing mainly on asylum seekers and refugees because they are the most vulnerable category. Asylum seekers are in stand-by mode, their life is put on hold. They are waiting for their situation to become clear, they stay here or are sent to their country of origin. It is a very harsh waiting period. Most are without their family, are aware of or are not aware of what goes on in their country of origin. We have focused on these groups, but, if we have had funding, we also took on projects for the other groups of migrants in need of assistance (….).

Rep.: Your foundation is present in all centres for asylum seekers in Romania…
C.D: Yes, but these centres obviously belong to the Ministry of Interior, it is they who manage the issue of foreign citizens in Romania. We have concluded cooperation conventions with these centres.

Rep.: What do these conventions imply?
C.D: First of all, they give us access to these centres. You can’t just go in there, I mean it’s not a train station and you can’t simply go and say “Hello, I’m here and I’m going now”.  We need space in these centres, in which we can carry out our activity, that we can equip, we need a schedule that they (r.n.: the representatives of the Ministry) must be aware of. This is of course provided by the cooperation agreements with the Ministry of Interior, which we began to conclude starting around 2002-2003, although we didn’t always have projects. Because we have been requested to provide assistance, we had these cooperation projects with them. Outside the centres, we have our own offices. I mainly refer to the office in Bucharest, where we have medical offices, psychotherapy offices, where they (r.n.: the refugees) may also come. We have a double circuit, we go and assist them in these centres of the Ministry of Interior, but they may also come to our office in Bucharest.

Rep.: How many people benefit from your assistance annually? Do you have any statistical data regarding this group of refugees, the asylum seekers?
C.D: Out of a group of 400-500 people, there is a percentage, let’s say around 11-12%, it depends on the political moment, the year and area they come from. On average, around 11-12%. Now, since they have been coming from Syria, all statistics are a mess. It’s not like in the past years, they come from a conflict area, a post-conflict area when they managed to get away, when dictators’ regimes changed; there are hundreds of people. We cannot replace the state because the state has its obligations towards these people in all areas. We add, in a way, to the state’s services and sometimes do more than that. For example, the healthcare the state offers to these people is close to zero.

Rep.: This is another issue that I wanted to discuss. I’ve looked over the law and, legally, the state should ensure that these people receive all the healthcare services they need. Why are your services still needed?
C.D: Medically, things are even worse because these centres are not properly staffed, there are no psychologists, there are no physicians. There is a physician, I think, in one centre, if this is still the case, and a couple of nurses. There are no psychologists. We provide all this assistance.

Rep: Does the state offer nothing?
C.D: The state has somehow delegated this responsibility to non-governmental organisations. Certainly the assistance would be complete if there was true cooperation. We say that we complement each other, but there are areas that remain uncovered. For example, nobody does a medical screening of these people. This simply does not exist. In terms of public health, there should be investigations to detect, for example, TB, Hepatitis B, infectious disease with a high risk  of spreading, HIV, AIDS and so on. This medical screening does not occur and we’ve had situations in which …. Let me give you an example: we’ve had cases of mental illness that went undetected, with no specialised personnel. Not being able to be all the time in those places to do the screening resulted in some people creating problems, becoming violent, and conflicts occurred due to lack of treatment. We have psychiatrists, they were included in certain treatment schemes…don’t ask me how we got the medication and who paid for it because psychiatric treatments are generally very expensive. Finally, we managed informally, but it is clear that we need a formal setting for these service networks. You can’t resort forever to colleagues who work in the hospital and who can willingly help you. We need a serious service network in place, one that works, one that has a certain flow and efficiency.
• Note: screening is an initial mass examination, consisting of applying a set of investigation procedures and techniques to a population for the purpose of presumably identifying diseases, anomalies or risk factors.

Rep.: Upon their reception, aren’t these people being medically examined to see whether they suffer from a contagious disease?
C.D: Well they aren’t.

Rep.: Unfortunately, it is not the first time that I hear that the reality in practice is not the same with the legislative reality, if we could say so, in this area of refugee assistance…
C.D: This is something that I could have also told you.

Rep.: If there’s an emergency and they end up in hospital, how are these people received? I’m asking this because I’ve recently come into contact with a foreign citizen, who lives in these centres and who has told us that he hasn’t received the necessary medication in the hospital and that he has rather received healthcare services and medication from non-governmental organisations.
C.D: Yes, because people don’t know this. There is an acute lack of information. We do not have the capacity of also doing this work, of informing the medical staff as to what they need to do when they encounter certain categories of the population, which are insured or not insured. These are things that are out of our area of competence, it is not our duty and we do not hold this capacity. How could I train the medical population in Romania in relation to the rights of asylum seekers?

Rep.: Ok, but practically speaking, what are the physicians in the hospital afraid of? That they will provide healthcare services and prescribe the necessary medication and these services will not be paid from the budget?
C.D: Normally, they should be free. From theory to the implementation of this right is again a long way. Everybody says that their healthcare services are ensured and when you start to ask them in detail: where, when, how and who – you’ll see that it is not quite so. Of course, there are free-of-charge services for emergencies, but it is not always so. The system does not provide a response, it is far behind these regulations.

Rep.: Is there a medical pattern? Do these people come with a certain type of area-specific problems?
C.D: They are diverse, mixed, pathology is as diverse as our pathology. Don’t imagine and take these clichés that I’ve encountered in my colleagues, that they come with exotic, tropical disease, and, alas, we won’t know to diagnose them. There is no such thing, they suffer from the same diseases and illnesses we suffer from and experience the same joy.

Rep.: As far as I can gather, the state provides no healthcare for refugees. What can you say about the other conditions in the centres? Do they have spaces for cooking, are there proper hygiene and living conditions?
C.D: It depends very much on the place we are at and on the persons in charge of these centres. There are places where people are kind and there are people who are less kind. And you can see this right away from how the centre is organised, from how clean it is, from how happy people are, what has been done. I don’t want to give examples because you can find out for yourself, you have field coverage, and there are only 6 centres. There are centres where the accommodation conditions are very good and there are centres where conditions are much more modest, to put it like this. It’s like in a home, some people manage better and live a decent life with the same money, others don’t.

Rep.: The law says that asylum seekers should benefit from a food quota of around 3,600 calories. Are they offered, apart from the amount of Lei 3, a food bonus in the centre?
C.D: They can’t ensure the necessary calories. It’s not quite 3600 calories as they don’t have much activity in this period. One of the problems is to find them an occupation. Because people doing nothing but waiting for a result and thinking “What will happen? What are those at home doing?” end up very quickly in depression. Certainly nobody can live on this amount. There are donations, there are people who make donations from their communities, from our community, but you won’t hear me telling you that a church has made a donation in this area. Churches, whether they’re ours or theirs, build these huge monsters, the people’s cathedral or some mosque. Huge buildings that cost exorbitant amounts of money. One could help thousands and thousands of people with that money. The Pope made an appeal to the Catholic community on this topic and I’m convinced it will be met. Nobody says anything in Romania, we’re scared “we, practising Christians are in danger”, but, on the other hand, how is our Christianity manifesting? Where is solidarity, where is the help to thy neighbour? Total silence. I don’t have high hopes. There are the communities, there are people donating whatever surplus they have, from their children, from themselves and we donate our clothes, children’s toys, whatever we have in excess.

Rep.: What is the situation in terms of hygiene? Have you met people who have become ill due to improper hygiene?
C.D: They receive personal hygiene products and products for the maintenance of the spaces they live in. Of course those mattresses need changing, they are written off or not. You know there are all sorts of rules, when it comes to these materials. Regarding time intervals for changing them and so on. Here the law is not flexible. If those people would like to, for instance, change their mattresses because they haven’t been used for 2-3 years and are full of fleas or whatever else, they can’t deduct them. I have found out these things because we came across a few practical problems. This time, it is not ill will of those managing these centres, but legislative constraints because, otherwise, mattresses that can’t be used will be burned …I don’t know, incredible non-sense.

Rep.: What can you tell me in general about the refugee crisis in Europe?
C.D: This is not a problem that has a universal solution, and that is why everybody is looking for a solution. It is a problem in which political interests are extremely visible and because of it there are different attitudes towards solving the problem, depending on political colour. In the end, I believe that a larger involvement of people, of the civil society is the key, is important. We organised, in other towns of Romania, but not in Bucharest, all sorts of meetings where people in such towns came and cooked, and then asylum seekers came, exchanged recipes, played football. In the end, if you want to meet these people, you must interact with them, not imagine that they bite and slice the throat of the first man they come across. When you start establishing relationships with them, you’ll see that only good will come out of it. It is an extraordinary human experience. That I can say without any reserve. (…) I am waiting for communication between the stakeholders in this area, on the one hand, the state’s authorities in charge of foreign citizens, the Ministry of Interior, through the Inspectorate for Immigration, the Ministry of Foreign Affairs, of Health, of Labour and organisations working for many years in the field and which have extremely valuable experience. There should be communication here, apropos of me making strategies: nobody has invited us. I’m telling you that nobody has invited us. I talk to them and, in general, they look to a computer screen, write in a search engine asylum seekers and refugees and begin reading. That’s the problem – they are completely disconnected from reality.(…) There are so many things one can do with little money. And to be kind is an issue of attitude, it doesn’t cost any money. To be normal, kind to these people brings you a normal and kind response from them. So, in the end, it is us who set the pace.

Present in University Square after the events that preceded the Revolution of 1989, the physician Camelia Doru was contacted by a team of Danish physicians who invited her to a training visit in Denmark. Once there, she visited, among other places, a centre of Chilean refugees. It was then when the Danish partners asked her whether such a centre would be necessary in Romania. She replied that “it is not our case”, our country being, at the time, a supplier of immigrants to the rest of Europe. On her way home, an idea came to her, which led to the setting-up of ICAR Foundation: after the revolution, Romania had its own victims persecuted and hunted down by the former Romanian Communist regime. So, in 1992, Camelia Doru left the operating room and incorporated ICAR Foundation to offer assistance to the former political prisoners and their families. With the support of renowned figures of the post-December period, such as Corneliu Coposu, and with the help of the Danish colleagues, in 1993, she manages to obtain the first grant from the European Union, amounting to Euro 20,000. In 2002, ICAR Foundation takes a step further by including in the assistance programmes the refugees, asylum seekers and the other vulnerable groups of migrants. Foreign citizens arriving in Romania have matched closely the conflict areas that marked the world in the past 13 years, says the physician. “It is now obvious for everybody, there is no need for statistics. Most of these people come from Syria, they are the majority.”

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